Rep. Barney Frank (D., Mass.), who is retiring from the House this year, now says that President Obama made a “mistake” in pushing for his signature health law. “I think we paid a terrible price for health care,” he told Jason Zengerle of New York magazine. “I would not have pushed it as hard. As a matter of fact, after [Republican] Scott Brown won [Sen. Kennedy’s old seat in Massachusetts], I suggested going back. I would have started with financial reform but certainly not health care.” But Frank’s reasoning carries pitfalls for conservative reformers as well as liberal ones.

Frank explains that it’s difficult to enact reforms that threaten to disrupt the arrangements of those who already have health insurance and are happy with the care they get. “Obama made the same mistake Clinton made,” says Frank. “When you try to extend health care to people who don’t have it, people who have it and are on the whole satisfied with it get nervous.” (h/t Jim Geraghty.)

Obama, says Frank, overinterpreted his mandate from the 2008 election. “The problem with health care is this: Health care is enormously important to people. When you tell them that you’re going to extend health care to people who don’t now have it, they don’t see how you can do that without hurting them. So I think he underestimated, as did Clinton, the sensitivity of people to what they see as an effort to make them share the health care with poor people.”

Let’s leave aside Frank’s accusation that the reason Obamacare is unpopular is because the middle class doesn’t want to “share the health care with poor people.” (The middle class does plenty of sharing already.) Before Republicans start chortling at Barney Frank’s admission of Obamacare’s unpopularity, it’s worth remembering that the overall problem he identifies makes sweeping market-oriented reforms difficult too.

That’s why, for example, Democrats go on about Republicans supposedly “ending Medicare as we know it,” even though that is patently dishonest, and why the new Republican plan for Medicare, endorsed by Paul Ryan and Mitt Romney, (1) doesn’t affect anyone over the age of 55, and (2) retains an option for people to stay on traditional Medicare if they so choose.

Many Republicans have aggressively pushed the critique that Obamacare prevents people from keeping their current arrangements, if they like them. But that critique would also apply to any plan that, say, eliminated the tax exclusion for employer-sponsored insurance, in order to help fund universal coverage (an idea favored by people like me).

If Republicans are lucky enough to gain power in November, they will face two challenges. Democrats will instinctively push back on any changes to our three health-care entitlements: Medicare, Medicaid, and the employer tax exclusion. In addition, much of the conservative base does not appreciate that health care reform is urgently needed, because conservatives tend to be the people who are happiest with their current arrangements.

What’s the solution? The solution has two parts. First, any proposals to replace Obamacare must be implemented gradually, over time, so as not to overly disrupt the arrangements that many Americans like. Secondly, the solution ought to be bipartisan, by pairing free-market reforms with expansion of coverage (a liberal priority).

For all the partisan bluster right now, if Obamacare is overturned or repealed, it’s hard for me to see centrist Democrats voting against a significant expansion of coverage sponsored by Republicans, out of spite. But I could be wrong.

Matty--if you were paying attention, that belonged on the thoughtful critique of Obama. I know you didn't write it, and it seemed like you didn't read it very carefully. It has the political analysis--quite correct--that Obama expended a tremendous amount of political capital and it created a backlash in the lower turn-out mid-term 2010 elections. All of that is obvious.

What is less obvious is that Obama, whatever the cost, accomplished something that President's since Nixon have tried to do without success. The Act gives coverage to 45 million who were uninsured. We shall see what the political calculation is in a higher turnout presidential election. The GOP did help itself, inadvertently, by deciding to nominate the sanest of the clowns that came out of the clown car. Too bad he is also the least likeable.

Wasn't B. Frank a proponent of the single payer (starts out as government option) health insurance option? Many on the left are disappointed in the ACA because it leaves so much of the existing medical delivery and payment system intact. In fact, I know some who are hoping the ACA mandate is ruled unconstitutional, since they see the ACA as a deterent to a single payer. Everyone has an angle in this.

I really see the ACA as the last gasp for the continuation of a, somewhat, privately financed health care system. If the ACA fails, I will bet on a Medicare for all proposal within 20 years that will be enacted.

Wasn't B. Frank a proponent of the single payer (starts out as government option) health insurance option?

Yes, as is Obama. Both have stated so unequivocally on camera. The difference is that Barney wanted to dispense with the niceties and do it now, while Obama admitted it might take up to 15 years to achieve it.

Windoggie, agreed. I didn't say that matty hadn't read it carefully as a gratuitous slap, but to raise the idea that there are much larger tactical questions afoot. I have little regard for Republican tactics on health care. Those who hate Obama, for reasons ranging from the melanin in his skin to their objection to the mandate to buy insurance, are focusing on the short game. One of the sources of Obama's brilliance is his focus on the long game. He played a masterful political game in getting a bill; his skill in many ways rivaled that of LBJ. Many on the left think he should have focused on the economy, or gotten a stronger bill. The recent history on the health care bill made it clear to me that there was no stronger bill to be had, nor the votes to break the fillibuster on further economic stimulus. So the health care bill was the foot in the door for a Federal role in cost-control--in what the Federal government is already paying 40% of, something that would cover the impoverished and save money for local governments who pay for emergency care anyway, and an important step that could not be retraced. Whatever Obama might have thought about compromising with the insurance companies and big pharma, there weren't the votes without them. But now they have skin in the game, and will not necessarily back repeal. So I think the Dems have the whip hand in preserving the bill and preventing repeal. The same tactics--fillibuster and talking points--will come back to haunt the reactionaries.

If anyone can salvage a win out of a Supreme Court loss, it is Obama. Mitt has abandoned the field in order to get the yahoo vote. Those who hate the idea of a Federal role in health care would never have voted for Obama; those who want a stronger role such as single payer, and the poor now covered, will never vote for Mitt. I think that to appeal to the middle and independents, Mitt would have to have said that he has a bettter plan, and perhaps his experience with health care in Massachusetts might have given him that insight. But taking a nuanced position on health care, whatever he really thought under the etch-a-sketch image, would have cost him the Re-thug nomination. Like McCain before him, he put his integrity in hock to make it to the starting line. So sad.

I'll be very surprised if the Supreme Court upholds the insurance mandate and the ACA. If they do shoot it down, then everything comes down to the November election. There's so much at stake, but if the Democrats take Congress (with a filibuster proof majority in the Senate) and the presidency, a single payer plan along the lines of Medicare could be easily achieved. Will the nation be disgusted and turned off by Republican lies that will be drilled into minds during the election campaign? I certainly hope so.

House Speaker Boehner was on Charlie Rose last night, and from his comments, you really can get a strong taste of falsehoods and misrepresentations the Republican Party will resort to curry attention and favor. Yet, nobody is reaching the levels of bold lies that Romney is now regularly uttering. I can only hope that the majority of voters out there are more discriminating and can see how empty the Republican dialog really is. Everything the Republicans will say will revolve around the economy and how President Obama failed. Despite all that they might say and misrepresent, we all know that the Republican's haven't been able to accomplish anything noteworthy, and all their efforts can be boiled down to being a consistent impediment on virtually everything the Democrats have promoted. Still though, if one was to consider the successes that Obama has racked up and contrast that with the sorry record of Republicans over the last three years, it so apparent to me that all the Republican dialog rings hollow.

I agree. The reason Obamacare is such a rats nest is because it tries to keep everyone happy. Start single payer now and let the insurance industry howl all they want.

I disagree. Adopting a single payer system is full of major issues:

1. Based on how Medicare functions these days...A single payer isolates the consumer from the process of controlling health care costs. Everyone receives care regardless of the use (or abuse) of the access to health care. No financial incentives are available for consumers to maintain health.
2. Medicare reimbursements have been treated like politics, rather than business. Some services receive more political attention and funding (dialysis for example) than others (mental health care) even when the economies do not justify it.
3. Currently, much of medical insurance is covered by employers. Rolling this into a government financed system will shift billions of dollars away from businesses to the government. States and municipalities currently pay for a lot of these costs through budgets. I'll bet you won't get it all back in the transition. Many unions provide insurance to retirees...same problem.
4. Medicare is starving for funds and needs an infusion of cash. Pulling Medicare into "Medicare For All" would do this, but would also delay hard decisions on end of life costs by diffusing those costs within the whole system costs.
5. Do we really want children's health care funding competing with elderly care within the same funding system?
6. Medicare supplementall insurance currently provides an additional check and balance against fraud within the system.
7. The health care system is making inroads in whole patient care and the resultant cost savings. Financial incentives (rather than penalties) is a more appropriate method to achieve those results.

You may see the ACA as a "rat's nest". I see it as a method that medical costs can be somewhat market driven while still providing health care for all. Our health care system is 16% of our GDP. A full-on change to single payer would cause havoc.

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